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Modicare Is Aspirational & Has Already Brought The Need For Paradigm Shift In Indian Healthcare Systems

The healthcare sector in India has seldom attracted traction in the past; but NHPS will surely be a gamechanger with international players sensing an opportunity to be partners in the ambitious programme

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The central takeaway and key showpiece of this year's Union Budget was the Narendra Modi  government's ambitious National Health Protection Scheme (NHPS) for over 10 crore poor and vulnerable families. In real numbers, an estimated 50 crore individual beneficiaries would get coverage of up to Rs 5 lakh per family per year.

This is undoubtedly the world's largest government-funded healthcare programme and Union Finance Minister Arun Jaitley has promised adequate funds for its smooth implementation.

This is the third major insurance programme of the NDA government after the Pradhan Mantri Fasal Bima Yojana PMFBY and the Pradhan Mantri Jeevan Jyoti Bima Yojana (PMJJBY). Launched three years ago, the PMJJBY offers benefits of insurance to masses. Here, the insured person can get a life cover of Rs 2 lakh for a premium of Rs 330 per annum. It is a one year cover, renewable from year to year. It is administered through LIC and some private life insurance companies. Individual bank account holders of participating banks aged between 18 years and 50 years can join the scheme.

But the NHPS is different. It will be part of an umbrella Ayushman Bharat scheme, along with a preventive healthcare component worth Rs 1,200 crore. "These two far-reaching initiatives under the Ayushman Bharat will build a New India 2022 and ensure enhanced productivity, well-being and avert wage loss and impoverishment," according to Jaitley.

Many have started calling the new scheme as Modicare, a take on Obamacare. But there is a huge difference between the two. Obamacare is also a Patient Protection and Affordable Care scheme brought out through an Act in 2010. Under this scheme, it requires citizens to have health insurance for at least nine months out of every twelve or be subject to a tax of 2.5 percent of a person's income. Its aim is to extend health insurance coverage to some of the estimated 15% of the US population who lack it. These people receive no coverage from their employers and are not covered by US health programmes for the poor and elderly.

One key differentiator under Modicare is that the poor and underprivileged eligible under the scheme need not take insurance. The government provides them with health cover. The scheme is aimed at the poor and the needy and the funding comes from the government. The aim is to make India healthier and stronger. And, of course, producing a better workforce for India's economic march ahead.

The eligibility for NHPS would be on the basis of deprivations data from the socio-economic caste census (SECC). Since health is a state subject, the states can decide on the model of implementation. They could opt for an insurance-based model like Rashtriya Swasthya Bima Yojana (RSBY) or a trust-based model like Central Government Health Scheme (CGHS).

Though several state governments have either implemented or supplemented health protection schemes providing varying coverage, Modicare is more aspirational.

The NHPS has been rightly described as the mother of all insurance schemes in the country with sum assured estimated to touch a whopping Rs 50 lakh crore! That would be almost one-third of India's stock market value, or market capitalisation.

The Modi government's focus is not just covering diseases and ailments too. The government has decided to reactivate the rural health centres to push towards preventive healthcare. These 1.5 lakh centres will now be recalibrated to bring healthcare system closer to the homes of people. These centres will provide comprehensive health care, including for non-communicable diseases and maternal and child health services. These centres will also provide free essential drugs and diagnostic services.

There are bound to be challenges due to sheer population size and uneven geographical spread. Enrolment of families may be tough, but there is a way out. The government can tap the Jan Dhan banking scheme to cover the families that need health cover.

The government also has a good template in Pradhan Mantri Fasal Bima Yojana for boosting penetration for crop insurance. Launched two years ago, the crop insurance scheme has turned out to be a success with business growing to around Rs 25,000 crore. This model could be used for the new health insurance scheme too. Also that the Govt. will ensemble more funds through the new Capital Gain Tax which can be used towards supporting the Ayushman Bharat funding gap, this was also indicated by the Finance Minister.

Implementation may also be a hurdle, though not insurmountable. The government should involve state-run hospitals in a big way for smooth takeoff of the scheme. The government should also look actively as ASHA workers at the grassroot level.

One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist ASHA or Accredited Social Health Activist. Selected from the village itself and accountable to it, the ASHAs are trained to work as an interface between the community and the public health system. This interface should be strengthened for the success of NHPS.

So should the Rural Health Clinic (RHC) program which is intended to increase access to primary care services in rural communities.

Mid-size hospitals and emerging healthcare services in tier 2 and 3 cities too should be roped in and there is an opportunity for healthcare to spread out to rural areas instead of being metro-centric.

The government should also leverage the strengths in information technology to reach out to the masses in rural areas. Telemedicine is a success, but there are other emerging fields like remote monitoring, health care at home and Artificial Intelligence.

The healthcare sector in India has seldom attracted traction in the past; but NHPS will surely be a gamechanger with international players sensing an opportunity to be partners in the ambitious programme.

The present government is known to thrive on challenges. The proposed NHPS could, in the future get bigger and could be a precursor of the Universal Insurance Scheme which will provide cover to all citizens.

In the end, to quote one of the senior Health Ministery official, the utmost task would be to build a robust IT systems which will become the backbone of this largest healthcare protection sheme in the world. Whether by roping in Mr Nilenkani to develop something like Aadhar infrastructure or by active role played by Niti Aayog, NIC & other govt. & private stakeholders, the gamechanger would be the development of a robust IT framework to be able to make this plan full-proof & close the possible holes, else it would prove to be fatal to the aspirations of our PM, whose name is now become synonymous to this plan. Definitely, everybosy prays for the success of this ambitious plan as its fate may also decide how long Mr 'Modi' is allowed to 'Care' for the countrymen!

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

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Swadeep Srivastava

The author is founder & Managing Partner of, personalized e-Valet for Medical Travellers

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